Childhood employment is widespread in the United States. In 1988, approximately 4 million American children (under age 18 years) were gainfully employed. Illegal child labor is also common. It occurs on farms, in service industries, and increasingly in sweatshops. Anecdotal reports and fragmented surveillance data suggest that work is a frequent cause of injury and illness in children. However, no epidemiologic study has been undertaken of the health hazards of child labor. To determine the frequency of work-related injury and illness in children, we propose to conduct a population-based epidemiologic study. We shall determine the incidence of occupational injury, illness and death in children working in New York State in the years 1978 through 1988. Incidence rates for each major category of injury and illness will be computed by age, sex, race, calendar year, geographic region, industry and occupation. Time trends will be assessed. Data on reported episodes of work- related injury and illness will be obtained from workers' compensation files, the statewide hospital discharge file, employers' reports to the U.S. Bureau of Labor Statistics (BLS), the New York State cancer and heavy metals registries, and death certificates. Because of underreporting of occupational injury and illness is common, our analysis will focus on conditions of high visibility and short latency, including traumatic death, amputation, fracture and head trauma. Demographic (denominator) data describing the population of employed children will be abstracted from the 1980 U.S. Census supplemented by the BLS Annual Demographic File. To assess patterns of toxic exposure to working children, we shall obtain information on use of hazardous materials in industry from NIOSH's National Occupational Hazard and Exposure Surveys and from the New York State Industrial Chemical Survey. To obtain detailed follow-up information on selected episodes of injury and illness (sentinel health events), we shall conduct a series of in-depth field investigations. These studies will evaluate clinical and epidemiologic features, assess risk factors for injury, and when appropriate measure exposures to toxic substances. From the data collected in this study, we will develop recommendations for the prevention of injury and illness in working children.